ArticleRMD open2026
Temporal evolution of synovial histopathology in rheumatoid arthritis across treatment periods: a large-scale analysis of 1770 surgical specimens using the Rooney score.
Article in RMD open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo evaluate temporal changes in rheumatoid arthritis (RA) synovial histopathology across treatment periods using the Rooney score in a surgical cohort.
methodsThis retrospective study included 1770 synovial specimens from 1150 patients who underwent orthopaedic surgery between 2011 and 2025. Specimens were classified into early biological disease-modifying antirheumatic drug (bDMARD) (2011-2013), established bDMARD (2014-2018) and contemporary targeted therapy (2019-2025) periods. Mixed-effects models included patient-level random intercepts. Sensitivity analyses used calendar year, 3-year intervals, specimen-count-based tertiles and operated-joint power Doppler (PD) grade.
resultsThe median total Rooney scores were 29 (IQR 20-36), 24 (19.25-34) and 23 (20-32) across the periods (p for trend <0.001), driven by lower lymphocytic infiltration. The combined lymphocytic infiltration score decreased from 11 (0-20; early period) to 2 (0-11; contemporary period). After full adjustment, the contemporary period remained associated with a lower Rooney score than the early period (β -1.61, 95% CI -2.74 to -0.48; p=0.005). Tertile analyses were consistent, whereas adding operated-joint PD grade attenuated period estimates. Janus kinase (JAK) inhibitor-treated specimens did not have lower scores than bDMARD-treated specimens without JAK inhibitor exposure. Residual lymphocytic infiltration remained detectable despite clinical or imaging remission.
conclusionsRA synovial histopathology evolved across treatment periods, with lower Rooney scores and marked reductions in lymphocytic infiltration. These changes appear to reflect broader contemporary RA management rather than a JAK inhibitor-specific effect, although tissue-level inflammation may persist despite clinical or imaging remission.
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